Evaluation of the utility of the integrated management of childhood illnesses algorithm for Hiv infection in children less than five years old at the Mbagathi district hospital, Nairobi

Abstract

Background: Due to the growing importance ofHIV/AlDS as a contributor to childhood mortality in high prevalence countries, an HIV component was added to the WHO/UNICEF strategy of Integrated Management of Childhood Illnesses (IMCI). Its objective was to enable primary-level health workers identify symptomatic HIV infected children in urgent need of referral for HIV testing and HIV-specific care. Validation studies of the IMCI HIV algorithm have reported variable performance due to regional differences in prevalent childhood diseases. Objective: To assess the performance of the Kenyan adaptation of the IMCI HIV algorithm in identifying symptomatic HIV infected children and to determine its performance in identifying infected children with severe immunosuppression. Methods: In this cross-sectional, descriptive study conducted at Mbagathi District Hospital, the sensitivity and specificity of the IMCI HIV algorithm to identify symptomatic HIV infection among hospitalized children was evaluated. After applying the IMCI HIV algorithm, the children were tested for HIV infection using antibody tests with confirmatory viral testing for those aged less than 18 months. CD4+ T-lymphocyte percentages were obtained to assess the immunological characteristics of the children Findings: Of three hundred children recruited in the study 58 (19.3%) were HIV infected. The IMCI algorithm had a sensitivity of 77.8%, specificity of 80.9%, PPV of 49 4% and NPV of 93.7% for identifying HIV infection. Inclusion of CD4 percentage cut-off for severe immunosuppression improved the sensitivity and PPV of the algorithm for identifying severe immunosuppression in HIV infection to 89.6% and 57.8% respectively. Specificity and NPV however declined to 34.6% and 76.9% respectively.

Conclusion: The IMCI HIV algorithm was useful in prioritizing HIV infected children urgently in need of a HIV test as it identified 89.6% of HIV infected children with severe immunosuppression as symptomatic